I work in several family-planning clinics serving low-income/uninsured women, many of whom have been on medroxyprogesterone (Depo-Provera) for more than 10 years. Should we be doing bone density measurements on those patients who have the resources? How much longer can they stay on medroxyprogesterone?
—Debbie Cline, MSN, OGNP, FNP, Roanoke, Va.

Ever since the FDA issued its “black box” warning on the risk of bone demineralization with long-term medroxyprogesterone use, providers have struggled to balance the needs and health concerns of the patients they serve. Depo-Provera has long been proven to be a safe, effective, and well-tolerated tool for patients who need reliable contraception.

Fortunately, there is growing pressure on the FDA to rescind its warning. Ongoing studies show that bone densities, while slightly suppressed during Depo-Provera use, rebound to normal after discontinuance, leaving no permanent deficit. There is no indication for screening or surveillance of bone density measurements.

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No maximum number of years of Depo-Provera use has been established. All patients using this medication should be counseled to exercise, maintain adequate calcium and vitamin D intake, and avoid smoking.
—Sherril Sego, MSN, FNP (104-3)